J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website http://www.journalmc.org

Case Report

Volume 4, Number 4, April 2013, pages 271-276

Microvascular Coronary Dysfunction in a Woman With Signs and Symptoms of Myocardial Ischemia but No Obstructive Coronary Artery Disease

Figures

Figure 1. Angiogram of left anterior descending (LAD): There was 60% reduction in LAD diameter measured by Quantitative Coronary Angiography (QCA) following intracoronary injections of 10^-4 acetylcholine (b) from baseline (a) indicating coronary endothelial dysfunction (normal response is vasodilatation). Arrows indicate position of tip of the Doppler flow wire.

Figure 2. Coronary Reactivity Testing measuring peak velocity cm/sec and left intracoronary flow reserve (CFR) before adenosine (a) and after infusion of adenosine (b). Normal CFR is > 2.5. Abnormal CFR in this patient confirms the diagnosis of MCD.

Table

**Table 1.** The Results of the Coronary Reactivity Testing
	Endothelial Dependant	Non-endothelial Dependant
Normal values include: Coronary Blood Flow (CBF) to Acetylcholine (Ach) > 50%, Intracoronary Flow Reserve (CFR) to Adenosine > 2.5, Quantitative Coronary Angiography (QCA) to Acetylcholine > 5% change, QCA to Nitroglycerin (NTG) > 20%. CRT was performed by infusing vasoactive substances through a guiding catheter placed in the left main coronary artery. Doppler guide-wire (0.014-inch diameter, FloWire, JOMED/Cardiometrics/Volcano, San Diego, California) was positioned in the proximal left anterior descending coronary artery.
Microvascular Dysfunction	Coronary Blood Flow to Ach Abnormal	CFR to Adenosine Abnormal
Macrovascular Dysfunction	QCA to Ach Abnormal	QCA to NTG Normal